47 results on '"Mvududu, Rufaro"'
Search Results
2. Point-of-care testing for sexually transmitted infections and HIV pre-exposure prophylaxis among pregnant women in South Africa, 2021–2022: randomised controlled trial
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de Voux, Alex, Nyemba, Dorothy Chiwoniso, Silliman, Miriam, Mashele, Nyiko, Mvududu, Rufaro, Myer, Landon, and Davey, Dvora Joseph
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Biomedical and Clinical Sciences ,Public Health ,Clinical Sciences ,Health Sciences ,Reproductive Medicine ,Clinical Research ,Clinical Trials and Supportive Activities ,Pediatric AIDS ,Prevention ,Infectious Diseases ,Sexually Transmitted Infections ,Mental Health ,Pediatric ,HIV/AIDS ,Reproductive health and childbirth ,Infection ,Good Health and Well Being ,Female ,Pregnancy ,Humans ,Pre-Exposure Prophylaxis ,Pregnant Women ,South Africa ,HIV Infections ,Sexually Transmitted Diseases ,Point-of-Care Testing ,CHLAMYDIA TRACHOMATIS ,NEISSERIA GONORRHOEAE ,TRICHOMONAS ,Medical Microbiology ,Public Health and Health Services ,Clinical sciences ,Public health - Abstract
ObjectivePregnant and postpartum women (PPW) in Southern Africa are at increased risk of acquiring HIV and curable sexually transmitted infections (STIs). Oral pre-exposure prophylaxis (PrEP) is safe and effective to use during pregnancy to reduce HIV acquisition and vertical transmission. Point-of-care (POC) STI testing can identify PPW at risk of HIV and facilitate risk-differentiated and person-centred counselling to improve PrEP initiation, persistence and adherence. We evaluated the impact of POC STI testing compared with STI syndromic management on PrEP outcomes among PPW in Cape Town, South Africa.MethodsThe STI and PrEP in Pregnancy Study enrolled PPW without HIV and ≤34 weeks pregnant at their regular antenatal care visit with follow-up after 1 month. PPW were randomised to receive POC STI testing or STI syndromic management. PPW randomised to POC STI testing self-collected vaginal swabs for Chlamydia trachomatis, Neisseria gonorhoeae and Trichomonas vaginalis (Cepheid GeneXpert) testing and were offered same-day treatment if diagnosed. We compared PrEP initiation at baseline, PrEP prescription refill at 1 month (persistence) and adherence through tenofovir-diphosphate detection in dried blood spots by randomisation arm. In a secondary analysis, we evaluated the association between an STI diagnosis (positive STI test or reporting STI symptoms) with PrEP outcomes.ResultsWe enrolled and randomised 268 pregnant women. Twenty-eight per cent of women were diagnosed with ≥1 STI. Overall, 65% of women initiated and 79% persisted on PrEP with no significant differences by randomisation arm. Secondary analysis demonstrated that an STI diagnosis (positive STI test or reporting STI symptoms) was associated with higher PrEP initiation (adjusted relative risk=1.28; 95% CI 1.08 to 1.52), controlling for arm, maternal and gestational age.ConclusionsPOC STI testing was not associated with PrEP initiation or persistence relative to syndromic management. However, improving STI diagnosis by supplementing syndromic management with POC STI testing could improve PrEP initiation among PPW.Trial registration numberNCT03902418; Clinical Trials.gov; 1 April 2019.
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- 2024
3. “So that’s why I found PrEP to be safest way to protect yourself”: exploring IPV experiences and impact on HIV prevention among pregnant and postpartum women in Cape Town, South Africa
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Miller, Amanda P, Dean, Sarah Schoetz, Court, Lara, Mvududu, Rufaro, Mashele, Nyiko, Wara, Nafisa J, Myer, Landon, Shoptaw, Steven, and Davey, Dvora L Joseph
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Public Health ,Health Sciences ,Violence Research ,Clinical Research ,Mental Health ,Alcoholism ,Alcohol Use and Health ,Prevention ,Violence Against Women ,Substance Misuse ,Pediatric ,HIV/AIDS ,Behavioral and Social Science ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Infection ,Reproductive health and childbirth ,Gender Equality ,Peace ,Justice and Strong Institutions ,Good Health and Well Being ,Female ,Humans ,Male ,Pregnancy ,South Africa ,Pregnant Women ,Intimate Partner Violence ,HIV Infections ,Postpartum Period ,Intimate partner violence ,HIV ,Alcohol use ,PrEP ,Public Health and Health Services ,Epidemiology ,Health services and systems ,Public health - Abstract
Intimate partner violence (IPV) occurs at alarmingly high rates towards pregnant women in South Africa. Experiences of emotional, physical, and sexual IPV in pregnancy can adversely impact the health and safety of mother and fetus. Furthermore, IPV is associated with increased risk of HIV, exacerbating the public health impact of violence among pregnant women in this HIV endemic setting. In-depth understanding of cultural and contextual drivers of experiences of IPV is a critical precursor to development of interventions effectively addressing this issue among pregnant women in South Africa. The present study examines factors contributing to IPV among pregnant women to identify potential points of intervention. We conducted twenty in-depth interviews with postpartum women who used oral pre-exposure prophylaxis (PrEP) in pregnancy and reported recent experiences of IPV and/or ongoing alcohol use in a township near Cape Town, South Africa that experiences a heavy burden of both HIV and IPV. Interpretive thematic analysis was used. Several patterns of IPV during pregnancy were identified and violence was frequently described as co-occurring with male partner alcohol use. A majority of women referenced oral PrEP as their preferred method for HIV prevention, highlighting the agency and discretion it provided as beneficial attributes for women experiencing IPV. Fear of judgement from peers for remaining with an abusive partner and a lack of clear community messaging around IPV were identified as barriers to disclosure and support-seeking. Addressing the lack of social support received by women experiencing IPV during pregnancy in South Africa is essential to comprehensive IPV programming.
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- 2024
4. Pregnancy outcomes following self-reported and objective-measured exposure to oral preexposure prophylaxis in South Africa.
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Davey, Dvora, Nyemba, Dorothy, Mvududu, Rufaro, Mashele, Nyiko, Johnson, Leigh, Bekker, Linda-Gail, Dean, Sarah, Bheemraj, Kalisha, Coates, Thomas, and Myer, Landon
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Female ,Humans ,Infant ,Newborn ,Pregnancy ,Pregnancy Outcome ,Anti-HIV Agents ,HIV Infections ,Premature Birth ,South Africa ,Birth Weight ,Self Report ,Emtricitabine ,Abortion ,Spontaneous ,Pre-Exposure Prophylaxis - Abstract
OBJECTIVE: To compare pregnancy outcomes using self-reported and objective levels of intracellular tenofovir diphosphate (TFV-DP) in pregnant women using preexposure prophylaxis (PrEP). DESIGN: We enrolled pregnant women >15 years without HIV at first antenatal care visit in an observational cohort study to compare pregnancy outcomes by PrEP use. METHODS: Exposure defined as: any PrEP use [tenofovir disoproxil and emtricitabine (TDF/FTC]) prescription + reported taking PrEP], or objectively-measured TFV-DP in dried blood spots in PrEP-using pregnant women. The primary outcome was a composite of pregnancy loss, preterm birth (
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- 2024
5. Integration of HIV pre-exposure prophylaxis (PrEP) services for pregnant and breastfeeding women in eight primary care clinics: results of an implementation science study
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Nelson, Aurelie, Bheemraj, Kalisha, Dean, Sarah Schoetz, de Voux, Alex, Hlatshwayo, Lerato, Mvududu, Rufaro, Berkowitz, Natacha, Neumuller, Caroline, Jacobs, Shahida, Fourie, Stephanie, Coates, Thomas, Gail-Bekker, Linda, Myer, Landon, and Davey, Dvora Joseph
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- 2024
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6. Psychosocial determinants of pre-exposure prophylaxis use among pregnant adolescent girls and young women in Cape Town, South Africa: A qualitative study
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Haribhai, Sonia, Khadka, Nehaa, Mvududu, Rufaro, Mashele, Nyiko, Bekker, Linda-Gail, Gorbach, Pamina, Coates, Thomas J, Myer, Landon, and Davey, Dvora Leah Joseph
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Biomedical and Clinical Sciences ,Clinical Sciences ,Immunology ,Pediatric AIDS ,Pediatric ,Prevention ,Mental Health ,Adolescent Sexual Activity ,Clinical Research ,HIV/AIDS ,Behavioral and Social Science ,Infectious Diseases ,Reproductive health and childbirth ,Infection ,Good Health and Well Being ,Gender Equality ,Female ,Humans ,Adolescent ,Pregnancy ,Young Adult ,Adult ,Pre-Exposure Prophylaxis ,HIV Infections ,Anti-HIV Agents ,South Africa ,Cohort Studies ,Adolescents ,young women ,Human Immunodeficiency Virus ,pre-exposure prophylaxis ,sub-Saharan Africa ,Medical Microbiology ,Public Health and Health Services ,Public Health ,Clinical sciences - Abstract
BackgroundIn South Africa, at least 7.5 million people (age ≥15 years) are living with Human Immunodeficiency Virus (HIV). In 2020, 220,000 new infections occurred, approximately one-third of which were among cisgender adolescent girls and women (age ≥15 years). The perspectives of pregnant adolescent girls and young women (AGYW) as key, targeted end-users of pre-exposure prophylaxis (PrEP) in this setting are not well known.MethodsWe purposively recruited participants enrolled in an ongoing cohort study at an urban antenatal clinic in Cape Town, South Africa for in-depth interviews between July-September 2020. We restricted our analysis to pregnant AGYW (age: 16-25 years) who initiated daily oral PrEP (Tenofovir/Emtricitabine) antenatally and self-reported either high PrEP persistence (≥25 days in the past 30 days and no missed PrEP collection), or low PrEP persistence and/or discontinuation (missing >5 days in the last 30 days or missed PrEP collection). The findings were organized thematically, per the adapted Health Behavior Model (2000), using Nvivo-v.1.5.ResultsWe interviewed 18 AGYW (mean age = 22 years), at a mean of 14 weeks postpartum. Higher self-esteem and high-quality study provider-client relationships, including empathic psychosocial support, facilitated PrEP continuation. Reported barriers included unstable social structure characteristics (i.e., financial hardship) and individual factors (i.e., unintended pregnancy, parental rejection, and inadequate peer- and [non-cohabiting] partner support). Participants self-perceived a need for PrEP, feeling susceptible to non-consensual, forced sex, or considering partners' (presumed) sexual risk-taking. Limited community awareness regarding PrEP availability and/or perceived complexity in navigating health system access to PrEP, impede continuation.ConclusionsPrEP-focused healthcare access pathways for pregnant and postpartum AGYW need to be simplified. Further research is needed on health system determinants (i.e., structural barriers, provider-client interactions, and related outcomes) of oral PrEP utilization. In 2022, South Africa announced regulatory approval of long-acting PrEP options (i.e., the dapivirine ring for non-pregnant women and injectable cabotegravir, respectively); these may mitigate implementation barriers reported in this study. However, the safety and efficacy of long-acting PrEP (e.g., injectables, implants) among pregnant or breastfeeding women, specifically, remains to be confirmed in this setting.
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- 2023
7. Preferences and acceptability for long-acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya.
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Wara, Nafisa, Mvududu, Rufaro, Marwa, Mary, Gómez, Laurén, Mashele, Nyiko, Orrell, Catherine, Kinuthia, John, John-Stewart, Grace, Myer, Landon, Hoffman, Risa, Pintye, Jillian, Davey, Dvora, and Moucheraud, Corrina
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Kenya ,PrEP ,South Africa ,breastfeeding ,long-acting ,pregnancy ,Pregnancy ,Humans ,Female ,Adult ,Kenya ,South Africa ,HIV Infections ,Postpartum Period ,Breast Feeding - Abstract
INTRODUCTION: Long-acting pre-exposure prophylaxis (PrEP) options could overcome barriers to oral PrEP persistence during pregnancy and postpartum. We evaluated long-acting PrEP preferences among oral PrEP-experienced pregnant and postpartum women in South Africa and Kenya, countries with high PrEP coverage with pending regulatory approvals for long-acting injectable cabotegravir and the dapivirine vaginal ring (approved in South Africa, under review in Kenya). METHODS: From September 2021 to February 2022, we surveyed pregnant and postpartum women enrolled in oral PrEP studies in South Africa and Kenya. We evaluated oral PrEP attitudes and preferences for long-acting PrEP methods in multivariable logistic regression models adjusting for maternal age and country. RESULTS: We surveyed 190 women in South Africa (67% postpartum; median age 27 years [IQR = 22-32]) and 204 women in Kenya (79% postpartum; median age 29 years [IQR = 25-33]). Seventy-five percent of participants reported oral PrEP use within the last 30 days. Overall, forty-nine percent of participants reported negative oral PrEP attributes, including side effects (21% South Africa, 30% Kenya) and pill burden (20% South Africa, 25% Kenya). Preferred PrEP attributes included long-acting method, effectiveness, safety while pregnant and breastfeeding, and free medication. Most participants (75%, South Africa and Kenya) preferred a potential long-acting injectable over oral PrEP, most frequently for a longer duration of effectiveness in South Africa (87% South Africa, 42% Kenya) versus discretion in Kenya (5% South Africa, 49% Kenya). Eighty-seven percent of participants preferred oral PrEP over a potential long-acting vaginal ring, mostly due to concern about possible discomfort with vaginal insertion (82% South Africa, 48% Kenya). Significant predictors of long-acting PrEP preference included past use of injectable contraceptive (aOR = 2.48, 95% CI: 1.34, 4.57), disliking at least one oral PrEP attribute (aOR = 1.72, 95% CI: 1.05, 2.80) and preferring infrequent PrEP use (aOR = 1.58, 95% CI: 0.94, 2.65). CONCLUSIONS: Oral PrEP-experienced pregnant and postpartum women expressed a theoretical preference for long-acting injectable PrEP over other modalities, demonstrating potential acceptability among a key population who must be at the forefront of injectable PrEP rollout. Reasons for PrEP preferences differed by country, emphasizing the importance of increasing context-specific options and choice of PrEP modalities for pregnant and postpartum women.
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- 2023
8. Recent Alcohol Use Is Associated With Increased Pre-exposure Prophylaxis (PrEP) Continuation and Adherence Among Pregnant and Postpartum Women in South Africa
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Miller, Amanda P, Shoptaw, Steven, Moucheraud, Corrina, Mvududu, Rufaro, Essack, Zaynab, Gorbach, Pamina M, Myer, Landon, and Davey, Dvora L Joseph
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Biomedical and Clinical Sciences ,Midwifery ,Public Health ,Health Sciences ,Reproductive Medicine ,Alcoholism ,Alcohol Use and Health ,Substance Misuse ,Pediatric ,Clinical Research ,Prevention ,Behavioral and Social Science ,HIV/AIDS ,Cardiovascular ,Reproductive health and childbirth ,Good Health and Well Being ,Female ,Humans ,Pregnancy ,Adult ,HIV Infections ,Anti-HIV Agents ,South Africa ,Pre-Exposure Prophylaxis ,Alcoholism ,Postpartum Period ,Medication Adherence ,pre-exposure prophylaxis ,alcohol use ,pregnancy ,HIV ,Clinical Sciences ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundSouth African women experience high levels of alcohol use and HIV infection during the perinatal period. Oral pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV risk. We examined associations between alcohol use and PrEP use during pregnancy and postpartum.MethodsThe PrEP in Pregnant and Postpartum women study is a prospective observational cohort of 1200 HIV-negative pregnant women enrolled at first antenatal care visit and followed through 12 months' postpartum in Cape Town, South Africa. The analytic sample comprised pregnant women who initiated PrEP at baseline and were not censored from study follow-up before 3-month follow-up. We examined associations between any or hazardous alcohol use (Alcohol Use Disorders Identification Test-Consumption score ≥3) in the year before pregnancy and PrEP continuation and adherence during pregnancy (self-report of missing
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- 2023
9. Point-of-Care Sexually Transmitted Infection Testing Improves HIV Preexposure Prophylaxis Initiation in Pregnant Women in Antenatal Care in Cape Town, South Africa, 2019 to 2021
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de Voux, Alex, Mvududu, Rufaro, Happel, Anna, Jaspan, Heather B, Nyemba, Dorothy Chiwoniso, Mashele, Nyiko, Myer, Landon, and Davey, Dvora Leah Joseph
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Public Health ,Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Prevention ,HIV/AIDS ,Sexually Transmitted Infections ,Infectious Diseases ,Clinical Research ,Mental Health ,Infection ,Reproductive health and childbirth ,Good Health and Well Being ,Female ,Pregnancy ,Humans ,Prenatal Care ,Pregnant Women ,South Africa ,Point-of-Care Systems ,Sexually Transmitted Diseases ,HIV Infections ,Pre-Exposure Prophylaxis ,Gonorrhea ,Prevalence ,Biological Sciences ,Medical and Health Sciences ,Clinical sciences ,Epidemiology ,Public health - Abstract
Background Preexposure prophylaxis (PrEP) programs present a platform for diagnostic sexually transmitted infection (STI) testing in low- and middle-income countries, and availability of targeted STI testing has been hypothesized to influence PrEP use. We evaluated the association of STI testing modality and PrEP uptake among pregnant women in antenatal care. Methods We enrolled pregnant, HIV-uninfected women (16 years or older) at their first antenatal visit with follow-up through 12 months postpartum. Women were offered oral PrEP and tested for Chlamydia trachomatis and Neisseria gonorrhoeae using a point-of-care (POC; Cepheid, August 2019-November 2020) or laboratory-based (Thermofisher, December 2020-October 2021) test. We compared the proportion of women initiating and continuing PrEP by STI test adjusting for confounders. Results We evaluated 1194 women (median age, 26 years [interquartile range, 22-31 years]) with an STI result (46% POC and 54% laboratory-based). The prevalence of any STI was the same in POC-tested (28%) and laboratory-tested (28%) women - 25% versus 23% for C. trachomatis (P = 0.35) and 7% versus 9% for N. gonorrhoeae (P = 0.11). Mean time from testing to result was 0 day for POC and 26 days for laboratory testing, and mean time from testing to treatment was 3 days for POC and 38 days for laboratory testing. Receiving a POC STI test was associated with higher PrEP initiation compared with women receiving a laboratory-based test (90% vs. 78%; adjusted odds ratio, 2.1; 95% confidence interval, 1.5-2.9), controlling for age, gravidity, STI diagnosis, intimate partner violence, gestational age, employment, HIV risk perception, and cohabiting status. Conclusions Point-of-care STI testing, offering same-day results and treatment initiation, may increase PrEP initiation among pregnant women in antenatal care.
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- 2023
10. Evaluating the use of oral pre-exposure prophylaxis among pregnant and postpartum adolescent girls and young women in Cape Town, South Africa.
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Khadka, Nehaa, Nianogo, Roch, Aldrovandi, Grace, Bekker, Linda-Gail, Coates, Thomas, Myer, Landon, Joseph Davey, Dvora, Nyemba, Dorothy, Mvududu, Rufaro, Mashele, Nyiko, Gorbach, Pamina, and Javanbakht, Marjan
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AGYW ,South Africa ,adherence ,breastfeeding ,cohort studies ,oral pre-exposure prophylaxis ,pregnant - Abstract
BACKGROUND: Adolescent girls and young women (AGYW) in South Africa are at a higher risk of acquiring HIV. Despite the increasing availability of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention, knowledge on PrEP use during pregnancy and postpartum periods at antenatal care (ANC) facilities remains inadequate. METHODS: Data from HIV-uninfected pregnant women in Cape Town, South Africa, were used in this study. These women aged 16-24 years were enrolled in the PrEP in pregnancy and postpartum (PrEP-PP) cohort study during their first ANC visit. Using the PrEP cascade framework, the outcomes of the study were PrEP initiation (prescribed tenofovir disoproxil fumarate and emtricitabine at baseline), continuation (returned for prescription), and persistence [quantifiable tenofovir diphosphate (TFV-DP) in dried blood samples]. The two primary exposures of this study were risk perception for HIV and baseline HIV risk score (0-5), which comprised condomless sex, more than one sexual partner, partner living with HIV or with unknown serostatus, laboratory-confirmed sexually transmitted infections (STIs), and hazardous alcohol use before pregnancy (Alcohol Use Disorders Identification Test for Consumption score ≥ 3). Logistic regression was used to examine the association between HIV risk and PrEP, adjusting for a priori confounders. RESULTS: A total of 486 pregnant women were included in the study, of which 16% were adolescents (aged 16-18 years) and 84% were young women (aged 19-24 years). The adolescents initiated ANC later than the young women [median = 28 weeks (20-34) vs. 23 weeks (16-34), p = 0.04]. Approximately 41% of the AGYW were diagnosed with sexually transmitted infection at baseline. Overall, 83% of the AGYW initiated PrEP use during their first ANC. The percentage of PrEP continuation was 63% at 1 month, 54% at 3 months, and 39% at 6 months. Approximately 27% consistently continued PrEP use through 6 months, while 6% stopped and restarted on PrEP use at 6 months. With a higher risk score of HIV (≥2 vs. ≤1), the AGYW showed higher odds of PrEP continuation [adjusted odds ratio: 1.85 (95% CI: 1.12-3.03)] through 6 months, adjusting for potential confounders. Undergoing the postpartum period (vs. pregnant) and having lower sexual risk factors were found to be the barriers to PrEP continuation. TFV-DP concentration levels were detected among 49% of the AGYW, and 6% of these women had daily adherence to PrEP at 3 months. CONCLUSIONS: AGYW were found to have high oral PrEP initiation, but just over one-third of these women continued PrEP use through 6 months. Pregnant AGYW who had a higher risk of acquiring HIV (due to condomless sex, frequent sex, and STIs) were more likely to continue on PrEP use through the postpartum period. Pregnant and postpartum AGYW require counseling and other types of support, such as community delivery and peer support to improve their effective PrEP use through the postpartum period. CLINICAL TRIAL NUMBER: ClinicalTrials.gov, NCT03826199.
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- 2023
11. Sexual Risk among Pregnant Women at Risk of HIV Infection in Cape Town, South Africa: What Does Alcohol Have to Do with It?
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Miller, Amanda P, Shoptaw, Steven, Mvududu, Rufaro, Mashele, Nyiko, Coates, Thomas J, Bekker, Linda-Gail, Essack, Zaynab, Groenewald, Candice, Petersen, Zaino, Gorbach, Pamina M, Myer, Landon, and Joseph Davey, Dvora L
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Public Health ,Health Sciences ,Adolescent Sexual Activity ,Clinical Trials and Supportive Activities ,HIV/AIDS ,Pediatric ,Substance Misuse ,Behavioral and Social Science ,Infectious Diseases ,Alcoholism ,Alcohol Use and Health ,Prevention ,Clinical Research ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,2.3 Psychological ,social and economic factors ,Aetiology ,Prevention of disease and conditions ,and promotion of well-being ,Cardiovascular ,Infection ,Reproductive health and childbirth ,Good Health and Well Being ,Female ,Humans ,Pregnancy ,HIV Infections ,Pregnant Women ,South Africa ,Sexual Behavior ,Alcohol Drinking ,Alcohol use ,HIV ,Sub-Saharan Africa ,Public Health and Health Services ,Social Work ,Public health - Abstract
This study examines baseline associations between alcohol use and HIV sexual risk among a cohort of HIV-uninfected pregnant women (n = 1201) residing in a high HIV burdened community in Cape Town, South Africa. Alcohol use was measured using a modified version of the Alcohol Use Disorder Identification Test (AUDIT). HIV sexual risk was measured through a composite variable of four risk factors: diagnosis with a STI, self-report of > 1 recent sex partners, partner HIV serostatus (unknown or HIV+) and condomless sex at last sex. Any past year alcohol use prior to pregnancy was reported by half of participants (50%); 6.0% reported alcohol use during pregnancy. Alcohol use prior to pregnancy was associated with increased odds of being at high risk of HIV (aOR = 1.33, 95% CI 1.05-1.68, for 2 risks and aOR = 1.47, 95% CI 0.95-2.27 for 3 risks). In addition to reducing alcohol use, several other strategies to address HIV sexual risk were identified. Evidence-based interventions to address alcohol use and other HIV sexual risk behaviors during pregnancy in South Africa are desperately needed. Qualitative work exploring individual and community level drivers of alcohol use among pregnant and breastfeeding women in this setting could support development of a culturally tailored intervention to address these issues in this population.
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- 2023
12. Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study
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Davey, Dvora Joseph, Nyemba, Dorothy C, Castillo‐Mancilla, Jose, Wiesner, Lubbe, Norman, Jennifer, Mvududu, Rufaro, Mashele, Nyiko, Johnson, Leigh F, Bekker, Linda‐Gail, Gorbach, Pamina, Coates, Thomas J, and Myer, Landon
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Prevention ,HIV/AIDS ,Mental Health ,Behavioral and Social Science ,Infectious Diseases ,Clinical Research ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Reproductive health and childbirth ,Infection ,Good Health and Well Being ,Female ,Pregnancy ,Humans ,Adult ,Adolescent ,Pre-Exposure Prophylaxis ,Cohort Studies ,HIV Infections ,Postpartum Period ,adherence ,breastfeeding ,pre-exposure prophylaxis ,pregnant ,PrEP ,South Africa ,postpartum ,Clinical Sciences ,Public Health and Health Services ,Other Medical and Health Sciences ,Clinical sciences ,Epidemiology ,Public health - Abstract
IntroductionDaily oral pre-exposure prophylaxis (PrEP) can reduce HIV acquisition. However, prevention effectiveness requires daily adherence prior to and during periods of sexual activity. Little is known about pharmacologic measures of PrEP adherence during pregnancy and postpartum and the factors related to optimal adherence during periods of sexual activity in this population.MethodsBetween August 2019 and October 2021, we enrolled pregnant women without HIV at their first antenatal care visit followed-up through 12 months postpartum. Eligible women ≥16 years old received HIV prevention counselling and were offered oral PrEP (TDF-FTC). We quantified tenofovir-diphosphate (TFV-DP) in dried blood spots in women who reported taking PrEP in the past 30 days (at quarterly follow-up visits). We used regression models with generalized estimating equations to evaluate correlates of TFV-DP (any vs. none, and ≥2 vs. 5/month vs. no sex or
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- 2022
13. Stepped care to optimize pre-exposure prophylaxis (PrEP) effectiveness in pregnant and postpartum women (SCOPE-PP) in South Africa: a randomized control trial
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Joseph Davey, Dvora Leah, Dovel, Kathryn, Cleary, Susan, Khadka, Nehaa, Mashele, Nyiko, Silliman, Miriam, Mvududu, Rufaro, Nyemba, Dorothy C, Coates, Thomas J, and Myer, Landon
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Public Health ,Health Sciences ,Cost Effectiveness Research ,Comparative Effectiveness Research ,Behavioral and Social Science ,Prevention ,Clinical Trials and Supportive Activities ,HIV/AIDS ,Clinical Research ,Reproductive health and childbirth ,Good Health and Well Being ,Anti-HIV Agents ,Female ,HIV Infections ,Humans ,Postpartum Period ,Pre-Exposure Prophylaxis ,Pregnancy ,Pregnant Women ,South Africa ,Tenofovir ,Pre-exposure prophylaxis ,PrEP ,PMTCT ,Pregnant ,Breastfeeding ,Persistence ,Protocol ,Randomized control trial ,Economic evaluation ,Public Health and Health Services ,Epidemiology ,Health services and systems ,Public health - Abstract
HIV incidence among pregnant and postpartum women remains high in South Africa. Pre-exposure prophylaxis (PrEP) use remains suboptimal in this population, particularly during the postpartum period when women's engagement with routine clinic visits outside PrEP decreases. Key barriers to sustained PrEP use include the need for ongoing contact with the health facility and suboptimal counseling around effective PrEP use. Stepped Care to Optimize PrEP Effectiveness in Pregnant and Postpartum women (SCOPE-PP), is a two-stepped unblinded, individually randomized controlled trial (RCT) that aims to optimize peripartum and postpartum PrEP use by providing a stepped package of evidence-based interventions. We will enroll 650 pregnant women (> 25 weeks pregnant) who access PrEP at a busy antenatal clinic in Cape Town at the time of recruitment and follow them for 15 months. We will enroll and individually randomize pregnant women > 16 years who are not living with HIV who are either on PrEP or interested in starting PrEP during pregnancy. In step 1, we will evaluate the impact of enhanced adherence counselling and biofeedback (using urine tenofovir tests for biofeedback) and rapid PrEP collection (to reduce time required) on PrEP use in early peripartum compared to standard of care (SOC) (n = 325 per arm). The primary outcome is PrEP persistence per urine tenofovir levels and dried blood spots of tenofovir diphosphate (TFV-DP) after 6-months. The second step will enroll and individually randomize participants from Step 1 who discontinue taking PrEP or have poor persistence in Step 1 but want to continue PrEP. Step 2 will test the impact of enhanced counseling and biofeedback plus rapid PrEP collection compared to community PrEP delivery with HIV self-testing on PrEP use (n = up to 325 postpartum women). The primary outcome is PrEP continuation and persistence 6-months following second randomization (~ 9-months postpartum). Finally, we will estimate the cost effectiveness of SCOPE-PP vs. SOC per primary outcomes and disability-adjusted life-years (DALYs) averted in both Step 1 and 2 using micro-costing with trial- and model-based economic evaluation. This study will provide novel insights into optimal strategies for delivering PrEP to peripartum and postpartum women in this high-incidence setting. NCT05322629 : Date of registration: April 12, 2022.
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- 2022
14. Low prevalence of hepatitis B virus infection in HIV-uninfected pregnant women in Cape Town, South Africa: implications for oral pre-exposure prophylaxis roll out
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Joseph Davey, Dvora, Hsiao, Nei-yuan, Wendy Spearman, C, Sonderup, Mark, Hu, Nai-Chung, Mashele, Nyiko, Mvududu, Rufaro, and Myer, Landon
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,Hepatitis - B ,Hepatitis ,Chronic Liver Disease and Cirrhosis ,Digestive Diseases ,HIV/AIDS ,Prevention ,Vaccine Related ,Clinical Research ,Immunization ,Liver Disease ,Infectious Diseases ,Infection ,Reproductive health and childbirth ,Good Health and Well Being ,Adult ,Cohort Studies ,Cross-Sectional Studies ,Emtricitabine ,Female ,HIV Infections ,Hepatitis B ,Hepatitis B Surface Antigens ,Hepatitis B virus ,Humans ,Infant ,Pre-Exposure Prophylaxis ,Pregnancy ,Pregnant Women ,Prevalence ,South Africa ,Tenofovir ,HIV ,Pre-exposure prophylaxis ,Pregnant ,Microbiology ,Medical Microbiology ,Clinical sciences ,Medical microbiology ,Public health - Abstract
BackgroundOral daily preexposure prophylaxis (PrEP) using emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) is recommended as standard of care for prevention in individuals at high risk for HIV infection, including pregnant and postpartum cisgender women. FTC/TDF is also active against hepatitis B virus (HBV); however, concern has been raised that providing PrEP to individuals infected with HBV could lead to hepatitis flares and liver injury, especially in the setting of suboptimal PrEP use.MethodsWe conducted a cross-sectional analysis of baseline data from the PrEP in pregnant and postpartum women (PrEP-PP) cohort study from February 2020-March 2022 in one antenatal care clinic in Cape Town, South Africa (SA) to evaluate: (1) the field performance of a point of care test (POCT) (Determine II, Abbott Inc., Japan) for diagnosis of hepatitis B surface antigen (HBsAg) in a maternity setting, (2) the prevalence of HBV in a cohort of pregnant women not living with HIV.ResultsWe enrolled 1194 HIV sero-negative pregnant women at their first antenatal visit. Median age was 26 years (IQR = 22-31 years); 52% were born before 1995 (before universal HBV vaccination had started in South Africa). Median gestational age was 22 weeks (IQR = 16-30 weeks). There were 8 POCT and laboratory confirmed HBV cases among 1194 women. The overall prevalence of 0.67% (95% CI = 0.34-1.32%). In women born before 1995, 8 of 622 women were diagnosed with HBsAg; the prevalence was 1.29% (95% CI = 0.65-2.52%), and in women born in 1995 or after (n = 572); the prevalence was 0% (95% CI = 0.0-0.67%). We confirmed the test results in 99.8% of the rapid HBsAg (Determine II). Sensitivity was 100% (95% CI = 68-100%). Specificity was 100% (95% CI = 99.67-100%).ConclusionThe prevalence of HBV was very low in pregnant women not living with HIV and was only in women born before the HBV vaccine was included in the Expanded Program of Immunization. The Determine II POCT HBsAg showed excellent performance against the laboratory assay. HBV screening should not be a barrier to starting PrEP in the context of high HIV risk communities.
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- 2022
15. Early pre-exposure prophylaxis (PrEP) initiation and continuation among pregnant and postpartum women in antenatal care in Cape Town, South Africa.
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Joseph Davey, Dvora Leah, Mvududu, Rufaro, Mashele, Nyiko, Lesosky, Maia, Khadka, Nehaa, Bekker, Linda-Gail, Gorbach, Pamina, Coates, Thomas J, and Myer, Landon
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Humans ,HIV Infections ,Anti-HIV Agents ,Prenatal Care ,Postpartum Period ,Pregnancy ,Adult ,South Africa ,Female ,Pre-Exposure Prophylaxis ,adherence ,breastfeeding ,cohort studies ,pre-exposure prophylaxis ,pregnant ,Clinical Research ,Prevention ,HIV/AIDS ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Reproductive health and childbirth ,Good Health and Well Being ,Clinical Sciences ,Public Health and Health Services ,Other Medical and Health Sciences - Abstract
IntroductionPre-exposure prophylaxis (PrEP) is a safe and effective prevention strategy to reduce women's risk of HIV in pregnancy and postpartum. Effective PrEP protection requires daily PrEP adherence, but little is known about maternal PrEP continuation and factors that influence PrEP use.MethodsThe PrEP in pregnancy and postpartum (PrEP-PP) study enrolled consenting pregnant, HIV-negative women at first antenatal care (ANC) visit with follow-up through 12 months postpartum. Eligible and consenting women and girls ≥16 years received HIV prevention counselling and were offered PrEP. Interviewers collected socio-demographic and behavioural data from participants at each visit. We analysed the proportion of women who initiated PrEP and the proportion who continued PrEP after 3 months with associated correlates by estimating the prevalence ratio adjusting for a priori confounders.ResultsBetween August 2019 and October 2021, we enrolled 1201 pregnant women (median gestation 21 weeks; age 26 years); 84% of women initiated PrEP at their first ANC visit (n = 1014); 55% were married or cohabiting. Overall, 66% of women on PrEP returned for a repeat prescription at 1 month; 58% returned at 3 months (n = 493 of 844). Almost one-half of women on PrEP reported a side effect at 1 month, mostly nausea/vomiting. Women on PrEP in the first and second trimesters had higher odds of reporting side effects (aOR 2.61; 95% CI 1.17-5.84) versus postpartum women. Women who reported side effects continued with PrEP less than those who did not report side effects (aPR = 0.87; 95% CI 0.77-0.97). Women with ≥1 previous pregnancy (aPR = 0.76; 95% CI 0.57-1.01) or were postpartum (aPR 0.85; 95% CI 0.75-0.97) were less likely to continue PrEP compared to women who were primigravid or pregnant. Women who reported having an HIV+ partner (aPR = 1.45; 95% CI 1.13-1.85) or high HIV risk perception (aPR = 1.20, 95% CI = 1.01-1.41) were more likely to continue on PrEP than those who had HIV-negative partners or low risk perception.ConclusionsPrEP initiation and early continuation were high in this setting, compared to other studies in women. Being postpartum and experiencing side effects were associated with lower PrEP continuation, presenting opportunities for counselling on early transient side effects. Interventions for postpartum women on PrEP are needed.
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- 2022
16. Pre-exposure Prophylaxis Recent Adherence With Real-Time Adherence Feedback and Partner Human Immunodeficiency Virus Self-Testing: A Pilot Trial Among Postpartum Women
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Davey, Dvora Leah Joseph, Dovel, Kathryn, Mvududu, Rufaro, Nyemba, Dorothy, Mashele, Nyiko, Bekker, Linda-Gail, Gorbach, Pamina M, Coates, Thomas J, and Myer, Landon
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Prevention ,Clinical Trials and Supportive Activities ,Behavioral and Social Science ,Infectious Diseases ,Clinical Research ,HIV/AIDS ,Infection ,Reproductive health and childbirth ,Good Health and Well Being ,adherence ,breastfeeding ,pre-exposure prophylaxis ,pregnant ,South Africa - Abstract
BackgroundPre-exposure prophylaxis (PrEP) is safe and effective in postpartum women. Human immunodeficiency virus self-testing (HIVST) for male partners combined with biofeedback counseling through real-time adherence measures may improve PrEP use among postpartum women.MethodsBetween August 2020 and April 2021, we randomized postpartum women who initiated PrEP in pregnancy 1:1 to the intervention group (HIVST + biofeedback counseling after urine tenofovir test) or to standard of care ([SOC] facility-based human immunodeficiency virus [HIV] tests and routine counseling without biofeedback). The outcomes of interest were PrEP adherence in the past 48-72 hours via urine tenofovir tests and partner HIV testing, measured 1-month after randomization. Secondary outcomes included the proportion of partners who tested for HIV and the discrepancy between self-reported PrEP adherence and urine tenofovir result.ResultsWe enrolled 106 women (median age = 26 years). At enrollment, 72% of women reported missing 5 of last week) with no tenofovir in urine test was lower in the intervention group (17% vs 46%; RR = 0.33; 95% CI = 0.17-0.67; P = .03). No social or clinical adverse events were reported in the intervention arm.ConclusionsThe HIVST for partners and biofeedback counseling increased levels of recent PrEP adherence, pointing to the importance of these interventions to support PrEP use in this population.
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- 2022
17. Low prevalence of Hepatitis B virus infection in HIV-uninfected pregnant women in Cape Town, South Africa: Implications for oral pre-exposure prophylaxis roll out
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Davey, Dvora Joseph, Hsiao, Nei-yuan, Spearman, Wendy, Sonderup, Mark, Hu, Nai-Chung, Mashele, Nyiko, Mvududu, Rufaro, and Myer, Landon
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,Infectious Diseases ,Vaccine Related ,HIV/AIDS ,Chronic Liver Disease and Cirrhosis ,Liver Disease ,Immunization ,Digestive Diseases ,Hepatitis ,Clinical Research ,Hepatitis - B ,Prevention ,6.1 Pharmaceuticals ,4.2 Evaluation of markers and technologies ,Evaluation of treatments and therapeutic interventions ,Detection ,screening and diagnosis ,Reproductive health and childbirth ,Infection ,Good Health and Well Being - Abstract
Background: Oral daily preexposure prophylaxis (PrEP) using emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) is recommended as standard of care for prevention in individuals at high risk for HIV infection, including pregnant and postpartum cisgender women. FTC/TDF is also active against HBV; however, concern has been raised that providing PrEP to individuals infected with HBV could lead to hepatitis flares and liver injury, especially in the setting of suboptimal PrEP use. Methods: : We conducted a cross-sectional analysis of baseline data from the PrEP in pregnant and postpartum women (PrEP-PP) cohort study from February 2020-March 2022 in one antenatal care clinic in Cape Town, South Africa (SA) to evaluate: (1) the field performance of a point of care test (POCT) (Determine II, Abbott Inc., Japan) for diagnosis of hepatitis b surface antigen (HBsAg) in a maternity setting, (2) the prevalence of HBV in a cohort of pregnant women not living with HIV. Results: : We enrolled 1194 HIV sero-negative pregnant women at their first antenatal visit. Median age was 26 years (IQR= 22-31 years); 52% were born before 1995 (before HBV vaccines had started in South Africa). Median gestational age was 22 weeks (IQR=16-30 weeks). There were 8 POCT and laboratory confirmed HBV cases among 1194 women. The overall prevalence of 0.67% (95% CI=0.34-1.32%). In women born before 1995, 8 of 622 women were diagnosed with HBsAg; the prevalence was 1.29% (95% CI=0.65-2.52%), and in women born in 1995 or after (n=572); the prevalence was 0% (95% CI=0.0-0.67%). We confirmed the test results in 99.8% of the rapid HBsAg (Determine II). Sensitivity was 100% (95% CI=68-100%). Specificity was 100% (95% CI=99.67-100%). Conclusion: The prevalence of HBV was very low in pregnant women not living with HIV and was only in women born before the HBV vaccine was included in the expanded vaccine program. The Determine II POCT HBsAg showed excellent performance against the laboratory assay. HBV screening should not be a barrier to starting PrEP in the context of high HIV risk communities.
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- 2022
18. Maternal PrEP Use in HIV-Uninfected Pregnant Women in South Africa: Role of Stigma in PrEP Initiation, Retention and Adherence
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Moran, Alexander, Mashele, Nyiko, Mvududu, Rufaro, Gorbach, Pamina, Bekker, Linda-Gail, Coates, Thomas J, Myer, Landon, and Joseph Davey, Dvora
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Mental Health ,Pediatric AIDS ,Prevention ,Behavioral and Social Science ,Clinical Research ,HIV/AIDS ,Pediatric ,Infection ,Reproductive health and childbirth ,Good Health and Well Being ,Anti-HIV Agents ,Female ,HIV Infections ,Humans ,Pre-Exposure Prophylaxis ,Pregnancy ,Pregnant Women ,South Africa ,PrEP ,HIV prophylaxis ,Stigma ,Public Health and Health Services ,Social Work ,Public Health - Abstract
Pregnant women in sub-Saharan Africa are at high risk of HIV acquisition and require effective methods to prevent HIV. In a cohort of pregnant women offered Pre-exposure prophylaxis (PrEP), we evaluate the relationship between internalized and anticipated stigma and PrEP initiation at first antenatal visit, 3-month continuation and adherence using multivariable logistic regression. High internalized and anticipated PrEP stigma are associated with lower PrEP care initiation at first antenatal visit (aOR internalized stigma = 0.06; 95% CI = 0.03-0.11 and aOR anticipated stigma = 0.55; 95% CI = 0.31-1.00) compared to women with low reported stigma, after controlling for covariates. Women whose partners have not been tested for HIV or whose serostatus remains unknown have 1.6-times odds of PrEP retention at 3-months compared to women whose partners have been tested (aOR = 1.60; 95% CI = 1.02-2.52) after adjusting for covariates. PrEP counseling and maternal PrEP interventions must consider individual- and relational-level interventions to overcome anticipated PrEP stigma and other barriers to PrEP initiation and adherence.
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- 2022
19. Pregnancy outcomes following self-reported and objective-measured exposure to oral preexposure prophylaxis in South Africa
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Joseph Davey, Dvora Leah, Nyemba, Dorothy C., Mvududu, Rufaro, Mashele, Nyiko, Johnson, Leigh, Bekker, Linda-Gail, Dean, Sarah Schoetz, Bheemraj, Kalisha, Coates, Thomas J., and Myer, Landon
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- 2024
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20. Pregnancy outcomes following self-reported and objective-measured exposure to oral preexposure prophylaxis in South Africa: an observational cohort study
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Davey, Dvora Leah Joseph, Nyemba, Dorothy C., Mvududu, Rufaro, Mashele, Nyiko, Johnson, Leigh, Bekker, Linda-Gail, Dean, Sarah Schoetz, Bheemraj, Kalisha, Coates, Thomas J., and Myer, Landon
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- 2023
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21. Sexual risk among pregnant women at risk of HIV infection in Cape Town, South Africa: What does alcohol have to do with it?
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Miller, Amanda P, Shoptaw, Steven, Mvududu, Rufaro, Mashele, Nyiko, Coates, Thomas J, Bekker, Linda-Gail, Essack, Zaynab, Groenewald, Candice, Peterson, Zaino, Gorbach, Pamina M, Myer, Landon, and Davey, Dvora L Joseph
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Pediatric ,Infectious Diseases ,HIV/AIDS ,Adolescent Sexual Activity ,Sexually Transmitted Infections ,Alcoholism ,Alcohol Use and Health ,Prevention ,Clinical Research ,Behavioral and Social Science ,Substance Misuse ,Aetiology ,6.1 Pharmaceuticals ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Evaluation of treatments and therapeutic interventions ,Prevention of disease and conditions ,and promotion of well-being ,2.3 Psychological ,social and economic factors ,Infection ,Reproductive health and childbirth ,Cardiovascular ,Good Health and Well Being - Abstract
This study examines associations between alcohol use and HIV sexual risk among a cohort of HIV-uninfected pregnant women (n=1201) residing in a high HIV burden community in South Africa. Alcohol use was measured using a modified version of the Alcohol Use Disorder Identification Test (AUDIT). HIV sexual risk was measured through a composite variable of four risk factors: diagnosis with a STI, self-report of >1 recent sex partners, partner HIV serostatus (unknown or HIV+) and condomless sex at last sex. Any past year alcohol use prior to pregnancy was reported by half of participants (50%); 6.0% reported alcohol use during pregnancy. Alcohol use prior to pregnancy was associated with increased odds of being at high risk of HIV (aOR=1.33 for 2 risks and aOR=1.47 for 3 risks). In addition to reducing alcohol use, several other strategies to address HIV sexual risk in this population were identified.
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- 2021
22. Prevention of congenital syphilis within antenatal PrEP services in South Africa: missed opportunities
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Joseph Davey, Dvora, primary, de Voux, Alex, additional, Hlatshwayo, Lerato, additional, Nelson, Aurelie, additional, Frigati, Lisa, additional, Bheemraj, Kalisha, additional, Wara, Nafisa, additional, Mvududu, Rufaro, additional, and Myer, Landon, additional
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- 2024
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23. Early pre-exposure prophylaxis (PrEP) initiation and continuation among pregnant and postpartum women in antenatal care in Cape Town, South Africa
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Davey, Dvora Leah Joseph, Mvududu, Rufaro, Mashele, Nyiko, Lesosky, Maia, Khadka, Nehaa, Bekker, Linda-Gail, Gorbach, Pamina, Coates, Thomas J., and Myer, Landon
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Maternal health services -- Statistics ,Patient compliance -- Statistics ,Pregnant women -- Care and treatment -- Statistics ,HIV infection -- Prevention -- Statistics ,Health - Abstract
Introduction: Pre-exposure prophylaxis (PrEP) is a safe and effective prevention strategy to reduce women's risk of HIV in pregnancy and postpartum. Effective PrEP protection requires daily PrEP adherence, but little is known about maternalPrEP continuation and factors that influence PrEP use. Methods: The PrEP in pregnancy and postpartum (PrEP-PP) study enrolled consenting pregnant, HIV-negative women at first antenatalcare (ANC) visit with follow-up through 12 months postpartum. Eligible and consenting women and girls >16 years received HIV prevention counselling and were offered PrEP. Interviewers collected socio-demographic and behaviouraldata from participants at each visit. We analysed the proportion of women who initiated PrEP and the proportion who continued PrEP after 3 months with associated correlates by estimating the prevalence ratio adjusting for apriori confounders. Results: Between August 2019 and October 2021, we enrolled 1201 pregnant women (median gestation 21 weeks; age 26 years); 84% of women initiated PrEP at their first ANC visit (n = 1014); 55% were married or cohabiting. Overall, 66% of women on PrEP returned for a repeat prescription at 1 month; 58% returned at 3 months (n = 493 of 844). Almost onehalf of women on PrEP reported a side effect at 1 month, mostly nausea/vomiting. Women on PrEP in the first and second trimesters had higher odds of reporting side effects (aOR 2.61; 95% CI 1.17-5.84) versus postpartum women. Women who reported side effects continued with PrEP less than those who did not report side effects (aPR = 0.87; 95% CI 0.77-0.97). Women with [greater than or equal to]1 previous pregnancy (aPR = 0.76; 95% CI 0.57-1.01) or were postpartum (aPR 0.85; 95% CI 0.75-0.97) were less likely to continue PrEP compared to women who were primigravid or pregnant. Women who reported having an HIV+ partner (aPR = 1.45; 95% CI 1.13-1.85) or high HIV risk perception (aPR = 1.20, 95% CI = 1.01-1.41) were more likely to continue on PrEP than those who had HIV-negative partners or low risk perception. Conclusions: PrEP initiation and early continuation were high in this setting, compared to other studies in women. Being postpartum and experiencing side effects were associated with lower PrEP continuation, presenting opportunities for counselling on early transient side effects. Interventions for postpartum women on PrEP are needed. Keywords: adherence; breastfeeding; cohort studies; pre-exposure prophylaxis; pregnant; South Africa, 1 | INTRODUCTION Women in sub-Saharan Africa face a high risk of HIV acquisition during pregnancy and breastfeeding [1]. HIV acquisition risk more than doubles for women during pregnancy and [...]
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- 2022
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24. Integration of HIV pre-exposure prophylaxis (PrEP) services for pregnant and breastfeeding women in eight primary care clinics: results of an implementation science study
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Nelson, Aurelie, primary, Bheemraj, Kalisha, additional, Dean, Sarah Schoetz, additional, de Voux, Alex, additional, Hlatshwayo, Lerato, additional, Mvududu, Rufaro, additional, Berkowitz, Natacha, additional, Neumuller, Caroline, additional, Jacobs, Shahida, additional, Fourie, Stephanie, additional, Coates, Thomas, additional, Bekker, Linda-Gail, additional, Myer, Landon, additional, and Davey, Dvora Joseph, additional
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- 2023
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25. Pregnancy outcomes following self-reported and objective-measured exposure to oral preexposure prophylaxis in South Africa
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Joseph Davey, Dvora Leah, primary, Nyemba, Dorothy C., additional, Mvududu, Rufaro, additional, Mashele, Nyiko, additional, Johnson, Leigh, additional, Bekker, Linda-Gail, additional, Dean, Sarah Schoetz, additional, Bheemraj, Kalisha, additional, Coates, Thomas J., additional, and Myer, Landon, additional
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- 2023
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26. Evaluating the use of oral pre-exposure prophylaxis among pregnant and postpartum adolescent girls and young women in Cape Town, South Africa
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Khadka, Nehaa, primary, Gorbach, Pamina M., additional, Nyemba, Dorothy C., additional, Mvududu, Rufaro, additional, Mashele, Nyiko, additional, Javanbakht, Marjan, additional, Nianogo, Roch A., additional, Aldrovandi, Grace M., additional, Bekker, Linda-Gail, additional, Coates, Thomas J., additional, Myer, Landon, additional, and Joseph Davey, Dvora L., additional
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- 2023
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27. Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study
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Joseph Davey, Dvora, primary, Nyemba, Dorothy C., additional, Castillo‐Mancilla, Jose, additional, Wiesner, Lubbe, additional, Norman, Jennifer, additional, Mvududu, Rufaro, additional, Mashele, Nyiko, additional, Johnson, Leigh F., additional, Bekker, Linda‐Gail, additional, Gorbach, Pamina, additional, Coates, Thomas J., additional, and Myer, Landon, additional
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- 2022
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28. Supplemental Material - Psychosocial determinants of pre-exposure prophylaxis use among pregnant adolescent girls and young women in Cape Town, South Africa: A qualitative study
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Haribhai, Sonia, Khadka, Nehaa, Mvududu, Rufaro, Mashele, Nyiko, Bekker, Linda-Gail, Gorbach, Pamina, Coates, Thomas J, Myer, Landon, and Joseph Davey, Dvora Leah
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110309 Infectious Diseases ,FOS: Health sciences - Abstract
Supplemental Material for Psychosocial determinants of pre-exposure prophylaxis use among pregnant adolescent girls and young women in Cape Town, South Africa: A qualitative study by Sonia Haribhai, Nehaa Khadka, Rufaro Mvududu, Nyiko Mashele, Linda-Gail Bekker, Pamina Gorbach, Thomas J Coates, Landon Myer, and Dvora L Joseph Davey in International Journal of STD & AIDS.
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- 2023
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29. Preferences and Acceptability for Long-Acting PrEP Agents Among Pregnant and Postpartum Women with Experience Using Daily Oral PrEP in South Africa and Kenya
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Wara, Nafisa J., primary, Mvududu, Rufaro, additional, Marwa, Mary M., additional, Gómez, Laurén, additional, Mashele, Nyiko, additional, Orrell, Catherine, additional, Moucheraud, Corrina, additional, Kinuthia, John, additional, John-Stewart, Grace, additional, Myer, Landon, additional, Hoffman, Risa, additional, Pintye, Jillian, additional, and Davey, Dvora L. Joseph, additional
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- 2022
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30. Point-of-Care Sexually Transmitted Infection Testing Improves HIV Preexposure Prophylaxis Initiation in Pregnant Women in Antenatal Care in Cape Town, South Africa, 2019 to 2021
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de Voux, Alex, primary, Mvududu, Rufaro, additional, Happel, Anna, additional, Jaspan, Heather B., additional, Nyemba, Dorothy Chiwoniso, additional, Mashele, Nyiko, additional, Myer, Landon, additional, and Davey, Dvora Leah Joseph, additional
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- 2022
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31. Sexual Risk among Pregnant Women at Risk of HIV Infection in Cape Town, South Africa: What Does Alcohol Have to Do with It?
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Miller, Amanda P., primary, Shoptaw, Steven, additional, Mvududu, Rufaro, additional, Mashele, Nyiko, additional, Coates, Thomas J., additional, Bekker, Linda-Gail, additional, Essack, Zaynab, additional, Groenewald, Candice, additional, Petersen, Zaino, additional, Gorbach, Pamina M., additional, Myer, Landon, additional, and Joseph Davey, Dvora L., additional
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- 2022
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32. Pre-exposure Prophylaxis Recent Adherence With Real-Time Adherence Feedback and Partner Human Immunodeficiency Virus Self-Testing: A Pilot Trial Among Postpartum Women.
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Joseph Davey, Dvora Leah, Joseph Davey, Dvora Leah, Dovel, Kathryn, Mvududu, Rufaro, Nyemba, Dorothy, Mashele, Nyiko, Bekker, Linda-Gail, Gorbach, Pamina M, Coates, Thomas J, Myer, Landon, Joseph Davey, Dvora Leah, Joseph Davey, Dvora Leah, Dovel, Kathryn, Mvududu, Rufaro, Nyemba, Dorothy, Mashele, Nyiko, Bekker, Linda-Gail, Gorbach, Pamina M, Coates, Thomas J, and Myer, Landon
- Abstract
BackgroundPre-exposure prophylaxis (PrEP) is safe and effective in postpartum women. Human immunodeficiency virus self-testing (HIVST) for male partners combined with biofeedback counseling through real-time adherence measures may improve PrEP use among postpartum women.MethodsBetween August 2020 and April 2021, we randomized postpartum women who initiated PrEP in pregnancy 1:1 to the intervention group (HIVST + biofeedback counseling after urine tenofovir test) or to standard of care ([SOC] facility-based human immunodeficiency virus [HIV] tests and routine counseling without biofeedback). The outcomes of interest were PrEP adherence in the past 48-72 hours via urine tenofovir tests and partner HIV testing, measured 1-month after randomization. Secondary outcomes included the proportion of partners who tested for HIV and the discrepancy between self-reported PrEP adherence and urine tenofovir result.ResultsWe enrolled 106 women (median age = 26 years). At enrollment, 72% of women reported missing <2 doses in the past 7 days; 36% of women had tenofovir present in her urine. One month after enrollment, 62% (n = 33) of women in the intervention arm had tenofovir present in their urine compared to 34% (n = 18) in SOC (risk ratio [RR] = 1.83; 95% confidence interval [CI] = 1.19-2.82; P = .001). Two thirds of women in the intervention arm reported that her partner tested for HIV (66%; n = 35), compared to 17% (n = 9) in SOC (RR = 3.89; 95% CI = 2.08-7.27; P < .001). Self-reported PrEP adherence (took PrEP >5 of last week) with no tenofovir in urine test was lower in the intervention group (17% vs 46%; RR = 0.33; 95% CI = 0.17-0.67; P = .03). No social or clinical adverse events were reported in the intervention arm.ConclusionsThe HIVST for partners and biofeedback counseling increased levels of recent PrEP adherence, pointing to the importance of these interventions to support PrEP use in this population.
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- 2022
33. Adherence challenges with daily oral pre-exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study.
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Joseph Davey, Dvora, Joseph Davey, Dvora, Nyemba, Dorothy C, Castillo-Mancilla, Jose, Wiesner, Lubbe, Norman, Jennifer, Mvududu, Rufaro, Mashele, Nyiko, Johnson, Leigh F, Bekker, Linda-Gail, Gorbach, Pamina, Coates, Thomas J, Myer, Landon, Joseph Davey, Dvora, Joseph Davey, Dvora, Nyemba, Dorothy C, Castillo-Mancilla, Jose, Wiesner, Lubbe, Norman, Jennifer, Mvududu, Rufaro, Mashele, Nyiko, Johnson, Leigh F, Bekker, Linda-Gail, Gorbach, Pamina, Coates, Thomas J, and Myer, Landon
- Abstract
IntroductionDaily oral pre-exposure prophylaxis (PrEP) can reduce HIV acquisition. However, prevention effectiveness requires daily adherence prior to and during periods of sexual activity. Little is known about pharmacologic measures of PrEP adherence during pregnancy and postpartum and the factors related to optimal adherence during periods of sexual activity in this population.MethodsBetween August 2019 and October 2021, we enrolled pregnant women without HIV at their first antenatal care visit followed-up through 12 months postpartum. Eligible women ≥16 years old received HIV prevention counselling and were offered oral PrEP (TDF-FTC). We quantified tenofovir-diphosphate (TFV-DP) in dried blood spots in women who reported taking PrEP in the past 30 days (at quarterly follow-up visits). We used regression models with generalized estimating equations to evaluate correlates of TFV-DP (any vs. none, and ≥2 vs. <2 doses/week), adjusting for maternal age and pregnancy status.Results and discussionIn 382 women who started PrEP in pregnancy, returned for follow-up and reported PrEP use in the past 30 days, the median age was 27 years (interquartile range [IQR] = 23-32), and the median time on PrEP was 168 days (IQR = 84-252 days). Half of the samples had quantifiable TFV-DP at any time point (52%), declining from 67% of pregnant women 3 months post-initiation to 31% of postpartum women by 12 months. Overall, 72% had concentrations corresponding to <2 doses/week; 25% ≥2 doses/week; 3% 7 doses/week. Concentrations were lower in postpartum versus pregnancy (age-adjusted odds ratio [aOR] = 0.44; 95% confidence interval [CI] = 0.35-0.54). The correlation of self-reported adherence and TFV-DP ranged from -0.07 in pregnancy to 0.25 in postpartum women. Variables associated with having quantifiable TFV-DP included partner living with HIV/unknown serostatus (aOR = 1.50; 95% CI = 1.01-2.22), and reported frequency of sexual activity in the past month (aOR sex >5/month vs
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- 2022
34. Low prevalence of Hepatitis B virus infection in HIV-uninfected pregnant women in Cape Town, South Africa: Implications for oral pre-exposure prophylaxis roll out
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Davey, Dvora Joseph, primary, Hsiao, Nei-yuan, additional, Spearman, Wendy, additional, Sonderup, Mark, additional, Hu, Nai-Chung, additional, Mashele, Nyiko, additional, Mvududu, Rufaro, additional, and Myer, Landon, additional
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- 2022
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35. Adherence to Daily Oral Pre-Exposure Prophylaxis (PrEP) During Pregnancy and the Postpartum Period in South African Women: A Cohort Study
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Davey, Dvora L. Joseph, primary, Nyemba, Dorothy, additional, Castillo-Mancilla, Jose, additional, Wiesner, Lubbe, additional, Norman, Jennifer, additional, Mvududu, Rufaro, additional, Mashele, Nyiko, additional, Johnson, Leigh F., additional, Bekker, Linda-Gail, additional, Gorbach, Pamina, additional, Coates, Thomas J., additional, and Myer, Landon, additional
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- 2022
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36. Pre-exposure Prophylaxis Recent Adherence With Real-Time Adherence Feedback and Partner Human Immunodeficiency Virus Self-Testing: A Pilot Trial Among Postpartum Women
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Joseph Davey, Dvora Leah, primary, Dovel, Kathryn, additional, Mvududu, Rufaro, additional, Nyemba, Dorothy, additional, Mashele, Nyiko, additional, Bekker, Linda-Gail, additional, Gorbach, Pamina M, additional, Coates, Thomas J, additional, and Myer, Landon, additional
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- 2021
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37. Sexual risk among pregnant women at risk of HIV infection in Cape Town, South Africa: What does alcohol have to do with it?
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Miller, Amanda Pearl, primary, Shoptaw, Steven, additional, Mvududu, Rufaro, additional, Mashele, Nyiko, additional, Coates, Thomas J, additional, Bekker, Linda-Gail, additional, Essack, Zaynab, additional, Groenewald, Candice, additional, Peterson, Zaino, additional, Gorbach, Pamina M, additional, Myer, Landon, additional, and Joseph Davey, Dvora L, additional
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- 2021
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38. Maternal PrEP Use in HIV-Uninfected Pregnant Women in South Africa: Role of Stigma in PrEP Initiation, Retention and Adherence
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Moran, Alexander, primary, Mashele, Nyiko, additional, Mvududu, Rufaro, additional, Gorbach, Pamina, additional, Bekker, Linda-Gail, additional, Coates, Thomas J., additional, Myer, Landon, additional, and Joseph Davey, Dvora, additional
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- 2021
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39. Pre-exposure prophylaxis adherence with real-time adherence feedback and partner HIV self-testing: A pilot trial among postpartum women
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Davey, Dvora Leah Joseph, primary, Dovel, Kathryn, additional, Mvududu, Rufaro, additional, Nyemba, Dorothy, additional, Mashele, Nyiko, additional, Bekker, Linda-Gail, additional, Gorbach, Pamina M., additional, Coates, Thomas J., additional, and Myer, Landon, additional
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- 2021
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40. Early pre-exposure prophylaxis (PrEP) discontinuation among pregnant and postpartum women: Implications for maternal PrEP roll out in South Africa
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Joseph Davey, Dvora Leah, primary, Mvududu, Rufaro, additional, Mashele, Nyiko, additional, Lesosky, Maia, additional, Khadka, Nehaa, additional, More, Jessica, additional, Bekker, Linda-Gail, additional, Gorbach, Pamina, additional, Coates, Thomas J., additional, and Myer, Landon, additional
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- 2021
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41. Travel and adherence to antiretroviral therapy among postpartum women living with HIV in South Africa: a cross-sectional study
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Mvududu, Rufaro and Phillips, Tamsin
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viral suppression ,South Africa ,antiretroviral therapy ,women ,adherence ,travel - Abstract
In sub-Saharan Africa, women are disproportionately affected by HIV. Sustained adherence to lifelong antiretroviral therapy (ART) is needed to ensure their own health and prevent transmission of HIV to their partners and their children. However, non-adherence to ART remains a substantial challenge with many associated risk factors. Travel is often reported in the qualitative literature as a barrier to ART adherence among women living with HIV, but few quantitative studies have explored this association. This research aimed to describe travel in the past year among mothers living with HIV in the Long-term Adherence and Care Engagement (LACE) study, to explore factors associated with travel, and to investigate the associations between travel and i) self-reported adherence, and ii) HIV viral load. Part A of this dissertation is the study protocol that introduces the need for this research and presents how the research will be carried out. Part B is a narrative literature review. The review summarises and synthesises existing research relating to HIV treatment and travel in sub-Saharan Africa, giving context to the dissertation. Part C is the journal “ready” manuscript. This section presents an analysis of data from the LACE study, a cross-sectional survey of women living with HIV approximately four years after they had started ART during pregnancy in Gugulethu, Cape Town. At the LACE study visit, data on short-term travel patterns (stayed away from home for 3 or more nights) in the past year and self-reported adherence in the past 30 days (using a validated three-item scale) were collected through structured questionnaires, and a blood specimen was tested for HIV viral load. Poisson regression models with robust standard errors were used to explore factors associated with travel (any versus none), self-reported adherence (100% versus
- Published
- 2020
42. Maternal PrEP use in HIV-uninfected pregnant women in South Africa: Role of Stigma in PrEP initiation, retention and adherence
- Author
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Moran, Alexander, primary, Mashele, Nyiko, additional, Mvududu, Rufaro, additional, Gorbach, Pamina, additional, Bekker, Linda-Gail, additional, Coates, Thomas J., additional, Myer, Landon, additional, and Davey, Dvora Joseph, additional
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- 2020
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43. RANDOMIZED EVALUATION OF THE IMPACT OF STI POINT-OF-CARE TESTING ON PrEP INITIATION.
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de Voux, Alex, Silliman, Miriam, Mvududu, Rufaro, Mashele, Nyiko, Myer, Landon, and Davey, Dvora Joseph
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- 2023
44. PREGNANCY AND BIRTH OUTCOMES FOLLOWING ORAL PrEP USE BY OBJECTIVE LEVELS OF TDF/FTC.
- Author
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Davey, Dvora Joseph, Nyemba, Dorothy C., Mvududu, Rufaro, Mashele, Nyiko, Bekker, Linda-Gail, Gorbach, Pamina M., Coates, Thomas J., and Myer, Landon
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- 2023
45. INTEGRATING PrEP INTO ANTENATAL CARE FOR HIV-NEGATIVE PREGNANT WOMEN IN SOUTH AFRICA.
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Nyemba, Dorothy C., Mvududu, Rufaro, Mashele, Nyiko, Bekker, Linda-Gail, Gorbach, Pamina M., Coates, Thomas J., Myer, Landon, and Davey, Dvora Joseph
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- 2023
46. Integration of HIV pre-exposure prophylaxis (PrEP) services for pregnant and breastfeeding women in eight primary care clinics: results of an implementation science study.
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Nelson A, Bheemraj K, Dean SS, de Voux A, Hlatshwayo L, Mvududu R, Berkowitz N, Neumuller C, Jacobs S, Fourie S, Coates T, Bekker LG, Myer L, and Davey DJ
- Abstract
Background: Although HIV vertical transmission (VT) has declined significantly in sub-Saharan Africa, incident HIV infection in pregnant and postpartum women is estimated to account for roughly one-third of VT. Oral pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women (PBFW) is part of the recommended guidelines in South Africa since 2021; however, integration of PrEP services within antenatal (ANC) and postnatal care (PNC) remains limited., Methods: Between March 2022 and September 2023, we evaluated the acceptability, feasibility and sustainability of integrating PrEP for PBFW in high-HIV prevalence clinics after training and mentoring health care providers (HCP). We used the Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) framework to evaluate the intervention. Acceptability and maintenance were defined as the proportion of PBFW without HIV who initiated PrEP and the proportion of women continuing PrEP at 3 months in ANC or PNC services. Feasibility was defined as the proportion of trained HCPs (HIV lay counsellors and nurses/ midwives) who provided PrEP according to national guidelines, measured through post-training surveys and in-service assessments. Sustainability was defined as number of facilities and providers that continued to provide PrEP for PBFW past the mentoring period., Results: In 8 facilities providing ANC and PNC, we trained 224 HCP (127 nurses and 37 counsellors). Of those, we mentored 60 nurses, midwives and HIV counsellors working with PBFW, with 72% of nurse/midwives and 65% of counsellors scoring over 8/10 on the final mentoring assessment Overall, 12% (1493/12,614) of HIV-negative pregnant women started PrEP and 41% of those continued PrEP at 3-months. Among the HIV-negative breastfeeding women in postnatal care, 179/1315 (14%) initiated PrEP and 25% continued PrEP at 3-months. All 8 facilities continued providing PrEP 3-months after handover of the clinics., Conclusion: Integration of PrEP services in ANC and services for breastfeeding women was feasible, acceptable and sustainable. Acceptability and PrEP continuation showed improvement over time. Barriers to the PrEP integration were observed including the lack of regular HIV testing of breastfeeding mothers and need for ART-trained nurses to prescribe PrEP. Enablers included motivated and dedicated staff., Competing Interests: Competing interests LGB: Honoraria from MSD (PTY) LTD, Gilead, ViiV Healthcare
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- 2023
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47. Recent Alcohol Use Is Associated With Increased Pre-exposure Prophylaxis (PrEP) Continuation and Adherence Among Pregnant and Postpartum Women in South Africa.
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Miller AP, Shoptaw S, Moucheraud C, Mvududu R, Essack Z, Gorbach PM, Myer L, and Davey DLJ
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- Female, Humans, Pregnancy, Adult, South Africa epidemiology, Postpartum Period, Medication Adherence, HIV Infections epidemiology, HIV Infections prevention & control, HIV Infections drug therapy, Anti-HIV Agents therapeutic use, Pre-Exposure Prophylaxis, Alcoholism drug therapy
- Abstract
Background: South African women experience high levels of alcohol use and HIV infection during the perinatal period. Oral pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV risk. We examined associations between alcohol use and PrEP use during pregnancy and postpartum., Methods: The PrEP in Pregnant and Postpartum women study is a prospective observational cohort of 1200 HIV-negative pregnant women enrolled at first antenatal care visit and followed through 12 months' postpartum in Cape Town, South Africa. The analytic sample comprised pregnant women who initiated PrEP at baseline and were not censored from study follow-up before 3-month follow-up. We examined associations between any or hazardous alcohol use (Alcohol Use Disorders Identification Test-Consumption score ≥3) in the year before pregnancy and PrEP continuation and adherence during pregnancy (self-report of missing <2 doses in past 7 days and biomarker-confirmed with tenofovir diphosphate in dried blood spots)., Results: Of 943 women on PrEP (median age of 26 years), 50% reported alcohol use before pregnancy, and 33% reported hazardous use. At 3-month follow-up, 58% of women were still using PrEP; 41% reported recent adherence, and 23% were biomarker-confirmed adherent. In multivariable models, hazardous alcohol use was associated with increased odds of continuing PrEP [adjusted odds ratio (aOR) = 1.54, 95% confidence interval (CI): 1.16-2.06], self-reported PrEP adherence (aOR = 1.41, 95% CI: 1.07-1.87), and biomarker-confirmed PrEP adherence (aOR = 1.35 95% CI: 0.98, 1.87). Associations were similar in models of any alcohol use and PrEP continuation/adherence., Conclusions: Pregnant and postpartum women who reported recent alcohol use had increased odds of continuing to take PrEP, indicating that higher risk women may continue on oral PrEP., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
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